Nursing is the most trusted profession in America and has been for 14 years in a row, according to a Gallup poll.i Because nurses form a social contractii with their patients and with society at large, accountability is an essential characteristic of the profession.
In today’s health care environment in which payers govern treatment decisions, the application of nursing skills, development of sound judgment, and delegation of nursing tasks can be particularly challenging. Nonetheless, nurses still must act in the patient’s best interests and they must take responsibility for their actions as caregivers.
Considering Provision 4
The American Nurses Association’s Code of Ethicsiii provides guidelines to help nurses recognize ethically challenging situations and to help them determine the best course of action. Let’s look at Provision 4, regarding responsibility. It states: “The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care.”
This means nurses are both responsible and accountable for the care they provide and the tasks they delegate.iv As a nurse, you are part of the decision-making team. Although many health care decisions are made collectively, you are individually responsible for the decisions you make each day and for the tasks you delegate. Note that while you can delegate tasks, you cannot ethically delegate judgments.
For example, you may ask a co-worker to check a temperature, but not to determine if that temperature is indicative of a spreading infection. That’s a judgment call you must make yourself or in consultation with colleagues or supervisors. Also, if you ask a co-worker to change an IV drip, you must ensure it actually was changed and, if not, see that it is. A nurse’s responsibility also means ensuring that dosages and medicines are correctly administered to the right patients. If errors occur, you are responsible for reporting them and rectifying the situation.
Emma works the day shift on an inpatient medical/surgical unit. The team is short one person, so a clinical associate from an outpatient neurology unit is assigned to cover the staffing gap. While conducting an initial assessment of Mrs. Brown, who was just admitted complaining of non-specific pain, the neurology associate informs Emma that Mr. Patterson’s, another patient from earlier in the day, temperature spiked more than one degree Fahrenheit when he received his second unit of blood during a transfusion. Emma continues working with Mrs. Brown and asks the clinical associate to recheck Mr. Patterson’s temperature before deciding to inform the charge nurse but does not follow up herself.
In keeping with Provision 4, did Emma appropriately transfer responsibility and accountability for Mr. Patterson’s care? Was it transferred to her new colleague or to the charge nurse? Can she realistically expect the substitute staffer to make the right decisions regarding Mr. Patterson’s care and the need to inform the charge nurse of a change in Mr. Patterson’s condition? Could his condition worsen before the charge nurse is notified? Which patient should have received Emma’s immediate attention? What options should she have considered?
As a student of Loyola University New Orleans, student nurses will be challenged with scenarios similar to the above and they will learn the best ways to remedy the situation.